Consistent pricing methodology
A unified pricing methodology provides consistency across all services, creating a dependable foundation for financial analysis and operational decision-making.
Flexible design
Our services offer a wide range of configuration options to meet the unique needs of your organization. Whether you're identifying outliers, managing non-priced services, or customizing validation rules, our solutions provide the flexibility and control needed to align with your analytic strategies.
Close critical data gaps
By supplementing missing or skewed unit cost information, this approach enables more robust and accurate use of encounter and claims data in analytic applications.
Why apply Normalized Pricing?
Normalized Pricing is a powerful solution for resolving gaps in unit cost data commonly found in administrative datasets, such as encounter data. It enhances the accuracy and consistency of cost analytics by applying a standardized pricing methodology across all services. This approach also streamlines insights derived from Symmetry and other grouping tools, enabling efficient analysis of practice variation. With commercially normalized unit costs, organizations can differentiate between provider efficiency and cost variation to assess true performance and drive value-based strategies.
How does it work?
Normalized Pricing methodologies are encapsulated through a structured set of reference tables and a software utility that can be seamlessly applied to customer data. The process utilizes readily available inputs from medical and pharmacy claims and encounter data, including procedure and diagnosis codes, to generate consistent and reliable pricing. This approach facilitates accurate cost normalization across diverse datasets, supporting robust analytics and informed decision-making
Is the Medicare Fee Schedule (MFS) published by CMS used in this process?
Yes, Normalized Pricing incorporates data from the Medicare Physician Fee Schedule (MFS), published by CMS, as a foundational source for pricing professional services. The Relative Value Units (RVUs) obtained from the MFS are then adjusted to reflect prevailing commercial payment levels observed across health plans, providing that the resulting normalized prices align with commercial market dynamics.
Are ICD-10 codes integrated into the product?
Yes, Normalized Pricing fully supports both ICD-10 and ICD-9 coding structures. A normalized price is applied regardless of which coding system is used on the claim. Additionally, when a claim includes both ICD-9 and ICD-10 codes for the same confinement, a claim indicator is used to identify this scenario. Normalized Pricing leverages this indicator to reference the appropriate code tables, providing accurate and consistent processing.
How will I know that my claims are priced consistently?
Normalized Pricing includes comprehensive summary and control reports that clearly outline pricing outcomes. These reports enable users to evaluate key metrics, such as the variance between actual payments and normalized costs, providing valuable insights into pricing performance and potential issues with the source data. During implementation, Optum partners closely with clients to review these reports and establish ongoing monitoring practices, providing continued alignment with business objectives.
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